Family gatherings can be difficult. All the emotional baggage and hurt feelings of the past can simmer beneath the surface. If allowed, these feelings can erupt in ugly ways. Here are a few tips to keep calm and help all family members enjoy their Thanksgiving dinner.
- Do not discuss politics. No one’s mind is going to be changed over dinner, but families can be permanently broken apart. Even if your politically-polarizing relative chides you, politely change the subject. Do not take the bait. There is nothing to be gained by discussing divisive topics.
- Do something nice for someone else. Show up Wednesday afternoon to help your grandmother put the leaf in the table and get the extra chairs from the attic. Drop off that old coat and knit hat at a collection place on your way to the airport. Make a donation to your local food bank or homeless shelter. One way to bring joy and give thanks for what you have is to help others who may not have the same gifts and blessings.
- Create a tradition of sharing gratitude. It might sound hokey, but having everyone share something for which they are grateful can sometimes put difficult family relations in perspective. It can also be an ice-breaker for those who are not accustomed to talking about their feelings. Reflecting on your blessings will improve your outlook and your patience.
- Lock up all medications. Millions of families are dealing with substance abuse and addiction. Unfortunately, Thanksgiving is a time when lots of people are in one place, which gives addicts an opportunity to steal medications. If someone at your Thanksgiving dinner has a problem with substance abuse, make sure all medications are locked away and are not accessible.
- Consider making your event alcohol free. Some people can’t imagine Thanksgiving dinner without alcohol. Others don’t really care one way or another. What is certain is that the more alcohol is involved in holiday gatherings, the more likely there are to be harsh words and broken relationships. Also, if you have someone in your family struggling with addiction or in early recovery, having an alcohol-free event can show your support for their recovery.
- Don’t judge. OK, so your great uncle is a loudmouth. Your niece’s boyfriend behaves in a way that is entitled, rude, and disrespectful. Your daughter is on some crazy diet and won’t eat anything you slaved over the stove for three days to make. Take a deep breath and remember why you are gathered. Focus on what is good instead of the irritations.
- Keep the visit brief. You are not required to spend the entire day with your family. If Thanksgiving is difficult, join the family for the meal and perhaps a short chat after and move on. Most people can be pleasant for an hour or two. Spend your time with those you rarely get to see, especially the elderly or the ill – and ask them how they are, instead of focusing on you.
I invite you to follow me on Twitter @ConScharffPhd and join me on Facebook.
November 22, 2017 Comments Off on Seven Tips for Enjoying a Family Thanksgiving Celebration
As an addiction treatment professional, it goes with the territory that we lose people, good people who maybe needed a little more help or time or who simply made a regrettable choice. Veterans are often among those lost to substance abuse and suicide.
My first and most devastating loss was of a young Marine, Scott,* who had returned to the US from multiple deployments in Iraq and Afghanistan. He was 23 and handsome, classic good looks – blonde hair, blue eyes, solid chin and impeccable manners. I like working with veterans and active duty military because I have yet to meet one without impeccable manners. When I knew Scott, he was living at a VA facility in California. Scott and I spoke often. He liked to watch me needlepoint. I understood Scott because although we had very different stories, we had both self-medicated our symptoms of post-traumatic stress. We were in a way, kindred spirits.
Scott had hoped for a career in the military, but had been wounded during his last deployment and could not continue in military service. He walked with a cane and was clearly in pain. Scott had a wife and a child that was only a few months old. He sought treatment at the VA for alcohol abuse related to post-traumatic stress disorder (PTSD).
The last time I saw Scott, he had arrived at the meeting hall earlier than normal. He sat in his usual chair at the end of the first row. He was shaking. I walked up to him right away and asked what was wrong. He told me that he had just come from therapy and was very upset. To treat trauma, the VA often uses exposure therapy. In this type of therapy, the individual recounts, and very often in their mind relives, the most traumatic experience(s) of their lives. Exposure therapy is the “gold-standard” for PTSD treatment, according to the VA.
Exposure therapy can be an effective tool for overcoming trauma-related symptoms. For example, if a woman was raped in a park, she may have a fear of going to a park – and this might prevent her from having a full relationship with her young child who likes parks. By reviewing the traumatic event in the park, the woman may be able to become desensitized and recognize that the trauma stems from an event, not from parks.
Unfortunately for some, there is no catharsis in reliving the worst moments of their lives. For these individuals, there is no desensitizing that goes on with exposure therapy. In fact, the therapy may exacerbate their PTSD symptoms. Scott did not benefit from exposure therapy. He did not tell his therapist that his PTSD symptoms were worsening. Rather than feeling he was a failure for discontinuing therapy or relapsing on alcohol to relieve his PTSD symptoms, Scott chose suicide as a way out of his pain.
Scott died nearly a decade ago. I didn’t know him well, but he was precious and he was pained. I think of him often, particularly on Veterans Day.
Could Scott have been saved? I don’t know. The VA certainly does its best. However, the staggering number of veteran suicides, now 20 per day down from 22 per day earlier in the decade, should indicate that we are not doing enough. Our services are either incomplete or inadequate, or not in the right places or veterans cannot or will not use them. Whatever the cause of the deficit, it is our responsibility to keep our promises to our wounded warriors of all types and do a better job of providing re-entry into our communities. We owe them a debt. We need to pay it.
*Not his real name.
November 11, 2017 Comments Off on To Honor Our Veterans, Let’s Keep Our Commitments to Them
It is clear with the latest healthcare proposal, the Senate’s Graham-Cassidy bill, that the GOP has no interest in genuine healthcare reform that would provide higher quality or less expensive health services to Americans. The proposal unremorsefully would decimate the quality of healthcare for millions of Americans, raise premiums, and make access to health insurance impossible for at least twenty million citizens. The Graham-Cassidy bill, which Senators hope to push through by the slimmest of votes, serves the purpose only of trying to eliminate Obama-era policies without any regard for the well-being of Americans. It is a heart-breaking effort most precisely because there is a chance that it could pass.
Today is Rosh Hashanah, the Jewish New Year and the beginning of a ten-day period of intense introspection that culminates with the holy day, Yom Kippur, the Day of Atonement. During this period, many Jews believe that the Book of Life is open. We pray to be inscribed for a good life and to be shown how we can live better. On Yom Kippur, when the Book of Life is sealed, we hope that our prayers and efforts to make important improvements in the way we live, will grant us mercy and strength to implement those changes through the year. It is not lost on me that the deadline for the Graham-Cassidy bill’s passage or defeat is also the day when our collective fate is sealed.
Bernie Sanders and his cohort have put out the call, again, to fill the phone lines with calls to Senators, demanding that they vote against this bill. No leading medical group supports the legislation. The medical groups I belong to are urging me once more to be sure that that my Senator votes against this legislation. Hasn’t the fact that similar proposals have failed twice already sent that message? It should have.
The Senate knows that Americans do not want this bill. I would rather, during this spiritually important period, devote myself to the charity work that calls so loudly – to evacuating people and livestock from the wildfires plaguing us here in the West; to collecting gift cards to support those devastated by hurricanes; to the food and coat drive that my synagogue runs to help our community as winter rolls in. I am frustrated. If our Senators can’t see that this is a deadly proposal, we need not waste our time showing them the fallacy of their ways. We need new Senators.
It is clear that the President’s base doesn’t like Obama. I completely understand that repeal of the Affordable Care Act was a rallying call for that base. We certainly can do better than the ACA, but until we can improve it, we cannot return to the days of pre-existing condition exclusions, annual or lifetime caps on coverage, enormous premium hikes, and lack of access to care for millions.
As I go to the synagogue to pray for a good year, I pray not only for myself, but for those who have no one to speak for them. I pray for the mentally ill and the addicts, the people I work with, who aren’t registered to vote and don’t have the ear of a Senator. The Torah commands that we choose life. It is for life, and for healthcare, that I pray. Senators, kill this bill before this legislation kills us.
I invite you to follow me on Twitter @ConScharffPhd and join me on Facebook.
September 21, 2017 Comments Off on Another Affordable Care Act Repeal Effort: The GOP’s Rosh Hashanah Prayer for American Deaths
Most of us who own horses talk about their “therapeutic” value. Being in the barn grooming, feeding, and otherwise caring for our horses reduces stress, lowers blood pressure and improves overall health. Yet, it is the companionship with our equine partners that is the foundation of our growth in relationship to these animals. Being with our horses is the “therapy.”
The power of this relationship has not been lost on medical professionals. “Equine therapy” is a popular tool to use with a variety of populations. But what is equine therapy and how is it used?
Equine Therapy Defined
According to PATH International, the Professional Association of Therapeutic Horsemanship, there are many different types of “equine assisted activities.” In its broadest sense, any interaction between a person and a horse is an equine assisted activity.
Equine-Assisted Therapy has a more specific goal. It is a treatment that uses horses to reach rehabilitative goals that are bounded by a medical professional’s scope of practice. Equine-Assisted Therapy is not an activity run by local horse clubs, church groups or trainers. Instead, it is overseen by a medical professional, usually a licensed psychotherapist or physical therapist. Equine-Facilitated Psychotherapy, which is used by addiction treatment facilities, veterans’ groups, and trauma centers, is always overseen by a licensed mental health professional. These types of therapies rarely involve riding the horse.
Benefits of Equine-Facilitated Psychotherapy
Especially for those who are unfamiliar with horses, working with horses can be an intimidating experience. Addicts, the population I work with, often exclaim, “They’re so big!” Indeed, as all horse-people know, trying to get a thousand-pound animal to do what you want is no easy task. If you are unaccustomed being honest and communicating clearly, the task becomes more difficult.
Horses can be an emotional mirror for humans. They respond to the feeling state we show. They are herd and prey animals, which means that they have a strong emotional sense and use this sense as a survival tool; they feed off of and respond to other horses in the herd. If one horse in a herd is scared, the others will become frightened. They respond similarly to humans. If a person approaches a horse with anger, the horse will respond by shying away or becoming stubborn. Horses never hide their emotions.
Because of these qualities, horses can be used to help people heal from a variety of psychological issues.
Identifying and Processing Feelings
First and foremost, horses can help individuals identify their feelings. Addicts in particular are known for numbing their feelings through the use of drugs and alcohol. When they get clean, they don’t know what to do with, or often how to identify, their feelings. This is a confusing and frustrating period for addicts. The horse, however, provides information to the client. If one walks angrily toward a horse, snatching its halter or lead, the horse will yank its head back and pull away. The therapist might ask the person, “What are you angry about?” Most of the time, the client will deny being angry and need to be shown the evidence of the horse’s behavior to identify the feeling. Addicts and other trauma survivors have to learn how to identify their emotions in order to work through them. Horses are a good tool for therapists to help clients do just that.
Horses can also open the door to re-visioning past traumatic events. Perhaps a plastic bag blows into the arena during a session, startling the horses. A client who has experienced child or domestic abuse might break down in tears upon seeing the horses frightened. It might remind him/her of experiences of powerlessness or helplessness, of being frightened, but having no-one to turn to. Any of these kinds of reactions is rich material for talk therapy and can be worked through immediately or in future sessions.
Horses require us to work. We get up early to feed and water. We clean stalls. We earn wages to buy feed and tack and maintain horse properties. Domestic horses have to be groomed, exercised, and attended to.
It is the same in the human world. Most of us have to work. Whether it is raising children or going to an office, factory or running a business, we get up early and show up on time. We participate in tasks that are not always easy or pleasant. We attend to our daily needs and those of others. We pay bills, clean the house, and keep the car in working order. We work hard and enjoy our moments of respite.
We also have to work to maintain our relationships. We listen to our friends, show up for our families, and provide service to our communities. Working hard and showing up in a healthy way are skills that can be learned by engaging with horses.
Horses are majestic animals that are wonderful simply to be with. Horses are gentle and honest; they do not have the ability to manipulate or lie. One common treatment technique for those who were abused as children is to put the (now adult) individual in with a large horse and allow them to interact. Very often, the person will break down in tears and say something like, “I’ve never been treated this kindly by anything so big.” This is an experience the client can then take into the human world.
Equine-Assisted Therapy, particularly Equine-Facilitated Psychotherapy, can have positive results for those who are recovering from substance abuse, trauma, depression, or a number of other psychological issues. It can help individuals develop a work ethic, identify and process feelings, and learn how to trust. However, to be safe and effective, Equine-Facilitated Psychotherapy must be provided by a licensed medical professional. As problematic feelings and memories arise, someone with experience helping people process those feelings must be present. The professionalism of those engaged with equine therapies is what makes them both effective and safe.
I invite you to follow me on Twitter @ConScharffPhd and join me on Facebook.
August 23, 2017 Comments Off on The Therapeutic Value of Horses
In response to his drug commission’s recommendation to declare the opioid overdose epidemic a national emergency, Trump demurred. Instead of taking the action his commission suggested, he spoke of ramping up law enforcement, in particular working to keep drugs from coming into the country. Trump blustered in favor what is already known to be a failed war on drugs policy, with no word at all about how to help the millions of Americans addicted to opioids right now.
The facts are startling. Every day an average of 142 Americans die from accidental overdose. In states across the nation, from Oregon to Ohio, to Florida, millions of children are in foster care because their parents are drug addicted and cannot care for them. In some states, as many as half the children in foster care are there because of parental substance abuse. Many others outside the foster care system live with family members who are not their parents. Whether through death or breaking up families, opioid addiction is tearing at the foundation of our homes.
A wall – to keep drugs or people out – doesn’t address the fundamental problem that we face. Opioid addiction wasn’t born out of an influx of drugs into the country. It was born out of an internal problem of overprescribing drugs that are unsafe for long-term use. Law enforcement aimed at international drug cartels does nothing to address this.
Help isn’t coming from the federal level. With that in mind, what then can we do, right now in our communities, to address the opioid overdose crisis?
The truth is that once you break up the family, the children are devastated and the addict loses motivation to recover. To keep families together, we have to focus on recovery.
First, stop the dying. All first responders and homes in which anyone uses opioids for more than a week need to have the opioid reversal drug, naloxone, on hand. Human decency demands that we save whomever we can. We also need to be able to offer quality addiction treatment of sufficient duration to allow people to recover. Now, there is a shortage of treatment beds available and those who can get treatment often are not allowed to stay more than a month before their insurance sends them home. Failing to invest in addiction treatment is failing to invest in families.
Second, address the crisis in foster care. There is no way around it. Children are victims of substance abuse and our foster care system is broken. Effort needs to be made to address system failures while more, good quality homes are opened up to children in need. Engaging clergy and faith-based organizations is the best place to start, to encourage loving families to make room for children with nowhere to go.
Third, advocate for quality state-run health exchanges that provide substance abuse treatment. While Trump and members of the GOP are hell-bent on undermining the Affordable Care Act, states must pick up the slack. This means being proactive and looking into ways to provide quality healthcare on a state-by-state basis.
Community based action that advocates for state-level changes is the only way forward. The federal government is stymied. We know what to do. Now, we have to roll up our sleeves and do it.
August 9, 2017 Comments Off on No, Mr. President, a Wall Won’t Stop Opioid Overdose Deaths
State Autonomy or Federal Negligence? Medicaid Cuts in the Fight Against Opioid Addiction
State and federal governments pay deeply for addiction. One study conducted by researchers at the National Center for Injury Prevention and Control estimates that the opioid addiction crisis has cost the United States more than $78 billion. The cost is staggering.
As President Trump and Congress consider deep cuts to Medicaid, a move designed to give states more freedom and curtail federal funding, public health advocates have to ask: is Trump’s proposed health care reform a nod to states’ independence or federal negligence to address a national addiction epidemic?
The dramatic decrease in funding key to Congress’ Medicaid reform proposal will have a ripple effect among the social service providers, institutions, individuals and families grappling with addiction. Most immediately, people looking for affordable addiction treatment services will struggle to find care. Nearly 30% of people covered by the Medicaid expansion overseen by President Obama are diagnosed with a mental health disorder or substance abuse disorder, accounting for more than 1.2 million Americans across the country. More than a million people will be denied access to life-saving treatment if the Medicaid expansion is retracted. Allowing hundreds of thousands of needy people to lose health coverage would be a national failure.
What services do remain accessible to people seeking addiction treatment will likely be determined based on cost, not efficacy. Medication-assisted treatment (MAT) for opioid dependence can be a clinically effective tool for treating opioid addiction, yet the high price of some MAT drugs like Suboxone may be enough to downsize states’ investments in this treatment modality. This includes Alaska and Kentucky, two of the states hit hardest by the opioid epidemic, where Medicaid pays for nearly 35% and 45% of all buprenorphine-assisted addiction treatment state wide, respectively. Forcing states to revoke health care coverage or specific treatments for people battling an addiction does not make states more independent or autonomous, but it does diminish states’ public services based on federal policy.
The impact of reduced funding for addiction treatment services on a state level will be tragic. With fewer resources to provide, fewer people will be able to access treatment when they need it the most, increasing the risk of accidental overdose. The Comprehensive Addiction Recovery Act (CARA) passed by Congress in 2016 identified first responders’ access to opioid overdose-reversal drug Naloxone as a key strategy for lowering opioid-related fatal overdoses. However, even this last resort intervention will not be secured for first responders until Congress passes a budget appropriating funds for CARA and all the services it outlines. States must wait on Washington to see if they’ll be provided with the necessary financial resources and support desperately needed to curb the opioid epidemic in their communities.
The relationship between states and the federal government on this issue doesn’t need to be complicated. States should be free to respond to their communities’ public health crises, including addiction, as they see fit. Where the federal government can provide much needed financial support to states in their efforts to prevent and treat addiction, particularly addictions to opioid-based pain killers, they have an obligation to do so. Funding effective addiction treatment should be a bipartisan issue.
April 25, 2017 Comments Off on State Autonomy or Federal Negligence? Medicaid Cuts in the Fight Against Opioid Addiction
The Impact of the Proposed Republican Reforms to the Affordable Care Act
Americans have gotten their first glimpse of proposed Republican reforms to the Affordable Care Act (ACA) and the news is not good for those who suffer from addiction and other vulnerable populations. The changes could make it impossible for many who currently have access to care to get treatment in the future, reversing the progress made by the ACA. The result, if the changes pass Congress, will mean a loss of life.
There is some good news in the Republican proposal. Some of the most important and popular aspects of the ACA will be retained. These include: 1) Young adults up to the age of 26 will be able to stay on their parents’ healthcare plan; 2) There will be no return to lifetime caps on healthcare; 3) There will be no return to “pre-existing” conditions. These are critical healthcare reforms that protect those who have health insurance, especially those who access health insurance through their employers.
The proposed changes to the healthcare system mainly come in the area of funding: who can access health insurance and how it will be paid for. In this regard, the changes are less positive, particularly for the poor and the aging.
One aspect of the ACA under attack by Republicans is Medicaid expansion. Under Obama, many states were able to expand Medicaid coverage. Some of those states, like Ohio, are among those that have been hardest hit by the opioid abuse epidemic.
Medicaid is currently funded on a flexible basis. States are paid based on the number of poor who are covered through the program. When the economy lags or a state has an increase in the number of people qualifying for Medicaid for other reasons, the federal government increases funding to pick up the slack. Medicaid is a true safety net under this system.
The current administration wants to change Medicaid funding to a block grant system. With block grants, the federal government pledges a specific amount of money to each state. This amount does not change based on need and is re-evaluated at three year intervals. In times when the economy lags, it is likely that the federal government will decrease funding to states, rather than increase it as the current system does. Most block grant funded programs atrophy. As federal Medicaid funding becomes increasingly unavailable, states that are unable to make up the losses will have larger and larger numbers of people without Medicaid coverage.
Older Americans will also suffer under this proposed ACA revision. Caps on how much insurance companies are able to charge older adults will significantly increase and although tax credits will switch from assisting the poorest Americans to assisting older Americans, it is unclear that these tax credits will cover the skyrocketing premiums older Americans will face.
These changes to the ACA are not a foregone conclusion. There is opposition among the farthest right wing of the Republican party, medical doctors and hospital associations, and elder rights advocates. At present, the legislation could not pass the Senate. To retain your healthcare coverage and that of the most vulnerable Americans, let your Senator know where you stand and that you vote.
April 25, 2017 Comments Off on The Impact of the Proposed Republican Reforms to the Affordable Care Act
Why Can’t People Get Healthcare in Rural America?
There is a medical crisis in rural America. There aren’t enough physicians to meet the needs of small towns, and the problem is only getting worse. According to the U.S. Department of Health and Human Services, there are more than 6,600 primary care health professional shortage areas (HPSA) scattered throughout the United States. The total number of HPSAs in the United States, including areas that lack adequate mental health services and dental care, is nearly 17,000. Most of these shortages occur in rural areas.
The same rural areas experiencing a shortage of medical services have also been hit hard by the ongoing opioid epidemic. In Ohio, a state with 382 HPSAs, an average of 30 people out of 100,00 will die due to an opioid-related overdose. In West Virginia, a state with 304 HPSAs, more than 41 out of 100,000 people will die from an opioid-related overdose. The overlap between areas experiencing high death rates as a result of the opioid epidemic and areas in critical need of basic health services is not a coincidence.
State and local governments have an obligation to recognize and correct healthcare shortages in rural areas. Current incentive programs to encourage doctors to invest time in rural communities must be improved and advanced, while new facilities must be built to accommodate community and geographic needs. Creative solutions to healthcare access, for example conducting therapy sessions or physician visits through video calls, must be explored in order to extend crucial treatment to the rural communities that might not otherwise have enough work for full-time specialty medical staff.
The federal government must continue to provide financial support to the state and local social service agencies striving to meet their communities’ needs. Reducing federal financial support to states, specifically in reductions to Medicaid, will not create better health outcomes for people addicted to drugs or experiencing mental illness. Instead, these cuts will shift the financial burden of treating these patients onto the states, resulting in a lack of treatment for low income populations altogether.
Whether improvements come from the states or federal government, many people can’t wait for the investment in healthcare infrastructure that rural areas so badly need. In place of local institutions, families with loved ones experiencing acute mental health issues or at risk of overdosing on opioids should consider traveling to another area or state where life-saving treatment services are available. Traveling to receive medical care is not an ideal option and it is not an option at all for those who can’t afford the price of a plane or bus ticket. However, desperate families should know they have this alternative available to them if getting help cannot be delayed.
Rural communities face an uphill battle when it comes to healthcare access. The geographic isolation of rural life makes it difficult to share physicians with neighboring counties, while the small populations guarantee a modest town budget with little room to accommodate social services. What assistance the federal government will continue to provide these towns in the form of Medicaid funding and other grants is up in the air. The current administration must prioritize access to mental health and addiction treatment services in rural areas, or the number of unnecessarily sick people and preventable deaths across the nation will continue to rise.
April 25, 2017 Comments Off on Why Can’t People Get Healthcare in Rural America?
The United States’ Greatest Barriers to Improved Mental Health Care Services and What Advocates Can Do to Enhance Care
What stops people who need mental health treatment from getting the support they need? While on average one in five American adults experiences some form of mental illness every year, just over 40% of people living with a mental health disorder receive treatment. What happened to discourage the other 60% of people from getting help and what can we do about it?
One of the greatest barriers to seeking mental health care is system capacity. There just aren’t enough mental health professionals or treatment centers available to meet the needs of the millions of Americans who need mental health treatment, including treatment for addiction.
Quality insurance coverage for mental health issues can also be a barrier to mental health treatment. Access to affordable health insurance eased somewhat with many states’ Medicaid expansions to include people within 138% of the federal poverty threshold. However, as Congress stands poised to repeal the Affordable Care Act (ACA), and without a concrete plan describing what will follow the ACA, some people may stand to lose their health insurance coverage. Estimates are that this number of people currently insured who will lose their access to care could be in the tens of millions.
The proposed shift in federal Medicaid funding from an open-ended entitlement program to a fixed-rate block grant is likely to decrease states’ available mental health resources as well. Opponents of the shift are concerned that one of the implicit goals of changing to a block grant funding structure is to save the government money, but in state budgets this cut could mean administrators will have to choose between the medical needs of different disadvantaged populations. If Medicaid becomes a block grant funded program, anyone utilizing the social safety net to connect to life saving treatment, including addiction treatment and outpatient counseling services, will likely lose some if not all of their benefits.
Entrenched social stigmas and cultural values also pose a major barrier to mental health treatment. Strict religious attitudes that equate mental health issues with moral weakness contribute to an environment that blames people for their mental health conditions instead of offering compassion and treatment.
While these and many other barriers to mental health treatment, including geographic location, primary language and immigration status, can prevent someone from getting the treatment they need, there is plenty that healthcare advocates can do to impact this situation. Participate in one of your state, city or county’s mental health awareness campaigns to raise the visibility of these issues and highlight the need for treatment and acceptance, not stigma. Petition your elected representatives directly to tell them a block-grant funding structure will spell disaster for people you care for if you know people who are benefiting from or need access to Medicaid. Find an organization working on affordable mental health care in your community and offer to volunteer in whatever way you can be of service. By recognizing our shared struggles and values, mental health care advocates can make a difference in the way our country addresses this vital issue.
January 30, 2017 Comments Off on The United States’ Greatest Barriers to Improved Mental Health Care Services and What Advocates Can Do to Enhance Care
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How Medicaid’s Addiction Treatment Services Will Change as a Block-Grant Program
Last weekend Counselor to the President, Kellyanne Conway, said in an interview that replacing the Affordable Care Act could include a shift in Medicaid’s financing to block grants. Since it was created in 1965, Medicaid has been a open-ended federal entitlement program, meaning that the federal government gave more money to states if medicine became more expensive or more people needed coverage through the program; the program matched changing needs. Given the ongoing opioid epidemic and the importance of affordable health care, what would a change to Medicaid’s financing mean for people receiving services through state-based Medicaid expansion programs?
One part of the Affordable Care Act authorized the federal government to finance an expansion of state Medicaid programs, increasing federal funding in state health expenses to cover Americans within 138% of the federal poverty level. Under federal law, anyone who qualified for the state-based insurance coverage was entitled to a certain level of care for an array of physical and mental health services, including addiction treatment services.
Currently the number of people accessing mental health or addiction treatment services varies greatly from state to state. In Ohio more than 500,000 adults received treatment for mental health and/or addiction treatment services through the state’s Medicaid expansion program, while states like Texas did not expand Medicaid at all. But because even the states that didn’t expand Medicaid still benefit from federal funding for patients at or below the national poverty level, anyone enrolled in Medicaid is likely to be impacted by the proposed shift to block grant financing.
Unlike how Medicaid funding works now, block grants do not respond to economic changes. Block grant funding is a type of financial dispersal in which the federal government gives states as a sum with general provisions on how it is to be spent. The amount is set, but states use it as they please. This is done because states vary in the types of programs they have to meet local needs. For example, the federal government might give each state a million dollars for road improvement. One state might fix potholes. Another might repair a bridge. A third might build part of a new road. All these expenditures would be allowable with a block grant for roads. Unfortunately, these grants do not take into account need, so a state that has an increased need for road improvement because of storm damage would not receive more aid based on that need.
Exactly what the change looks like will vary depending on the kind of block grants the federal government administers to states. In a fixed rate model, the government agrees to pay states a fixed amount of money, no matter how many people need coverage or what kinds of health services they need.
Alternatively, the federal government could agree to pay states a certain amount of money for each person the state’s Medicaid program elects to cover. This per capita allotment model is intended to account for ebbs and flows in the economy, when more or fewer people utilize government safety nets to meet basic needs like health coverage. This will cost the federal government more in times when the economy is poorest. Also, unless they’re adjusted for inflation both fixed and per-capita block grants would mean a smaller and smaller pool of funds every year, suggesting a slow death of attrition for Medicaid as a federal program.
Twelve percent of Medicaid enrollees are diagnosed with a substance use disorder (SUD). If federal funding for health care shrinks overall and coverage for all conditions decreases, it makes sense that coverage for addiction treatment services will decrease as well. Limiting access to addiction treatment services could be a disaster, resulting in thousands of preventable deaths.
It is crucial that everyone be able to access quality addiction treatment, no matter their income. At the end of Conway’s interview, she confirmed that President Trump is committed to keeping health care affordable and accessible to all. In order to meet this goal, special attention needs to be paid to health care services to the poor and how those services will be funded.
January 25, 2017 Comments Off on How Medicaid’s Addiction Treatment Services Will Change as a Block-Grant Program